Concordance Between Patient-Reported and Clinically Documented Symptoms in Acute Myeloid Leukemia

To describe the frequency and documentation patterns of patient-reported and clinically documented symptoms, and to determine the degree of concordance and discordance between patient-reported symptoms and electronic health record (EHR) documentation.

31 adult patients with acute myeloid leukemia hospitalized at a large academic tertiary healthcare center.

Self-reported symptoms were collected using a modified Memorial Symptom Assessment Scale, in which patients reported symptoms experienced during the prior seven days. Clinician-documented symptoms were manually extracted from clinical notes and nursing flow sheets in the EHR. Concordance and discordance were evaluated using Cohen's kappa and McNemar's tests.

Lack of energy (87% patients, 87% clinicians) and lack of appetite (74% patients, 84% clinicians) were the most frequently reported symptoms. However, many symptoms, particularly psychosocial symptoms such as feeling sad (n = 17 patients, 2 clinicians; kappa = -0.01, p = 0.001) and feeling irritable (n = 10 patients, 2 clinicians; kappa = -0.12, p = 0.043), showed substantial discordance and were often underdocumented in the EHR, suggesting that subjective patient experiences may be overlooked in routine documentation.

Accurate and comprehensive symptom documentation is essential for effective symptom management and clinical decision-making. Integrating structured symptom assessment tools or patient-reported outcomes into the EHR may improve documentation accuracy and enhance the quality of care for patients with acute myeloid leukemia.